Comparison Among Different High Porosity Stent Configurations: Hemodynamic Effects of Treatment in a Large Cerebral Aneurysm

2014 ◽  
Vol 136 (2) ◽  
Author(s):  
Breigh N. Roszelle ◽  
Priya Nair ◽  
L. Fernando Gonzalez ◽  
M. Haithem Babiker ◽  
Justin Ryan ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Simulation ◽  
Cerebral Aneurysms ◽  
Post Treatment ◽  
Patient Specific ◽  
High Porosity ◽  
Velocity Magnitude ◽  
Large Patient ◽  
Aneurysm Model

Whether treated surgically or with endovascular techniques, large and giant cerebral aneurysms are particularly difficult to treat. Nevertheless, high porosity stents can be used to accomplish stent-assisted coiling and even standalone stent-based treatments that have been shown to improve the occlusion of such aneurysms. Further, stent assisted coiling can reduce the incidence of complications that sometimes result from embolic coiling (e.g., neck remnants and thromboembolism). However, in treating cerebral aneurysms at bifurcation termini, it remains unclear which configuration of high porosity stents will result in the most advantageous hemodynamic environment. The goal of this study was to compare how three different stent configurations affected fluid dynamics in a large patient-specific aneurysm model. Three common stent configurations were deployed into the model: a half-Y, a full-Y, and a crossbar configuration. Particle image velocimetry was used to examine post-treatment flow patterns and quantify root-mean-squared velocity magnitude (VRMS) within the aneurysmal sac. While each configuration did reduce VRMS within the aneurysm, the full-Y configuration resulted in the greatest reduction across all flow conditions (an average of 56% with respect to the untreated case). The experimental results agreed well with clinical follow up after treatment with the full-Y configuration; there was evidence of thrombosis within the sac from the stents alone before coil embolization was performed. A computational simulation of the full-Y configuration aligned well with the experimental and in vivo findings, indicating potential for clinically useful prediction of post-treatment hemodynamics. This study found that applying different stent configurations resulted in considerably different fluid dynamics in an anatomically accurate aneurysm model and that the full-Y configuration performed best. The study indicates that knowledge of how stent configurations will affect post-treatment hemodynamics could be important in interventional planning and demonstrates the capability for such planning based on novel computational tools.

scholarly journals Morphological and Hemodynamic Changes during Cerebral Aneurysm Growth

2021 ◽  
Vol 11 (4) ◽  
pp. 520
Author(s):  
Emily R. Nordahl ◽  
Susheil Uthamaraj ◽  
Kendall D. Dennis ◽  
Alena Sejkorová ◽  
Aleš Hejčl ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Kinetic Energy ◽  
Swirling Flow ◽  
Morphological Changes ◽  
Cerebral Aneurysms ◽  
Patient Specific ◽  
Aneurysm Wall ◽  
Aneurysm Growth ◽  
Computational Fluid Dynamics Cfd

Computational fluid dynamics (CFD) has grown as a tool to help understand the hemodynamic properties related to the rupture of cerebral aneurysms. Few of these studies deal specifically with aneurysm growth and most only use a single time instance within the aneurysm growth history. The present retrospective study investigated four patient-specific aneurysms, once at initial diagnosis and then at follow-up, to analyze hemodynamic and morphological changes. Aneurysm geometries were segmented via the medical image processing software Mimics. The geometries were meshed and a computational fluid dynamics (CFD) analysis was performed using ANSYS. Results showed that major geometry bulk growth occurred in areas of low wall shear stress (WSS). Wall shape remodeling near neck impingement regions occurred in areas with large gradients of WSS and oscillatory shear index. This study found that growth occurred in areas where low WSS was accompanied by high velocity gradients between the aneurysm wall and large swirling flow structures. A new finding was that all cases showed an increase in kinetic energy from the first time point to the second, and this change in kinetic energy seems correlated to the change in aneurysm volume.

A Hybrid Coil/Polymer Device for Occlusion of Cerebral Aneurysms

2009 ◽  
Vol 3 (4) ◽  
Author(s):  
Fangmin Xu ◽  
Kevin Hart ◽  
Claire E. Flanagan ◽  
John C. Nacker ◽  
Roham Moftakhar ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
In Vitro Models ◽  
In Vivo Studies ◽  
Polymer Shell ◽  
Device Implantation ◽  
Occlusion Device ◽  
Aneurysm Occlusion ◽  
Aneurysm Model

The treatment of cerebral aneurysms is frequently accomplished via endovascular delivery of metal coils in order to occlude the aneurysm and prevent rupture. This procedure involves imprecise packing of large lengths of wire into the aneurysm and often results in high rates of aneurysm recanalization. Over time, this incomplete aneurysm occlusion can lead to aneurysm enlargement, which may have fatal consequences. This report describes the fabrication and preliminary testing of a novel aneurysm occlusion device composed of a single metal coil surrounded by a biocompatible polymer shell. These coil-in-shell devices were tested under flow conditions in synthetic in vitro models of saccular aneurysms and deployed in vivo in a short-term porcine aneurysm model to study occlusion efficacy. A single nickel titanium shape memory wire was used to deploy a biocompatible, elastic polymeric shell, leading to aneurysmal sac filling in both in vitro and in vivo aneurysm models. The deployment of this coil-in-shell device in synthetic aneurysm models in vitro resulted in varying degrees of aneurysm occlusion, with less than 2% of trials resulting in significant leakage of fluid into the aneurysm. Meanwhile, in vivo coil-in-shell device implantation in a porcine aneurysm model provided proof-of-concept for successful occlusion, as both aneurysms were completely occluded by the devices. Both in vitro and in vivo studies demonstrated that this coil-in-shell device may be attractive as an alternative to traditional coil embolization methods in some cases, allowing for a more precise and controlled aneurysm occlusion.

Exploring High Frequency Temporal Fluctuations in the Terminal Aneurysm of the Basilar Bifurcation

2012 ◽  
Vol 134 (9) ◽  
Author(s):  
Matthew D. Ford ◽  
Ugo Piomelli
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
High Frequency ◽  
Cerebral Aneurysms ◽  
Patient Specific ◽  
Disturbed Flow ◽  
Frequency Fluctuations ◽  
Wall Shear ◽  
Inflow Jet

Cerebral aneurysms are a common cause of death and disability. Of all the cardiovascular diseases, aneurysms are perhaps the most strongly linked with the local fluid mechanic environment. Aside from early in vivo clinical work that hinted at the possibility of high-frequency intra-aneurysmal velocity oscillations, flow in cerebral aneurysms is most often assumed to be laminar. This work investigates, through the use of numerical simulations, the potential for disturbed flow to exist in the terminal aneurysm of the basilar bifurcation. The nature of the disturbed flow is explored using a series of four idealized basilar tip models, and the results supported by four patient specific terminal basilar tip aneurysms. All four idealized models demonstrated instability in the inflow jet through high frequency fluctuations in the velocity and the pressure at approximately 120 Hz. The instability arises through a breakdown of the inflow jet, which begins to oscillate upon entering the aneurysm. The wall shear stress undergoes similar high-frequency oscillations in both magnitude and direction. The neck and dome regions of the aneurysm present 180 deg changes in the direction of the wall shear stress, due to the formation of small recirculation zones near the shear layer of the jet (at the frequency of the inflow jet oscillation) and the oscillation of the impingement zone on the dome of the aneurysm, respectively. Similar results were observed in the patient-specific models, which showed high frequency fluctuations at approximately 112 Hz in two of the four models and oscillations in the magnitude and direction of the wall shear stress. These results demonstrate that there is potential for disturbed laminar unsteady flow in the terminal aneurysm of the basilar bifurcation. The instabilities appear similar to the first instability mode of a free round jet.

scholarly journals A Workflow for Patient-Individualized Virtual Angiogram Generation Based on CFD Simulation

2012 ◽  
Vol 2012 ◽  
pp. 1-24 ◽  
Author(s):  
Jürgen Endres ◽  
Markus Kowarschik ◽  
Thomas Redel ◽  
Puneet Sharma ◽  
Viorel Mihalef ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Blood Flow ◽  
Shear Stress ◽  
Cfd Simulation ◽  
Cerebral Aneurysms ◽  
Patient Specific ◽  
Hemodynamic Parameters ◽  
Risk Of Rupture ◽  
Computational Fluid Dynamics Cfd ◽  
Subsequent Comparison

Increasing interest is drawn on hemodynamic parameters for classifying the risk of rupture as well as treatment planning of cerebral aneurysms. A proposed method to obtain quantities such as wall shear stress, pressure, and blood flow velocity is to numerically simulate the blood flow using computational fluid dynamics (CFD) methods. For the validation of those calculated quantities, virtually generated angiograms, based on the CFD results, are increasingly used for a subsequent comparison with real, acquired angiograms. For the generation of virtual angiograms, several patient-specific parameters have to be incorporated to obtain virtual angiograms which match the acquired angiograms as best as possible. For this purpose, a workflow is presented and demonstrated involving multiple phantom and patient cases.

The Pipeline Versus Telescoping Stents: In Vitro Flows in a Treated Cerebral Aneurysm Model

2012 ◽  
Author(s):  
Breigh N. Roszelle ◽  
M. Haithem Babiker ◽  
Justin Ryan ◽  
L. Fernando Gonzalez ◽  
Felipe Albuquerque ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
World Population ◽  
High Porosity ◽  
Recurrence Rates ◽  
Interventional Devices ◽  
Aneurysm Occlusion ◽  
Basilar Tip Aneurysm ◽  
Aneurysm Model ◽  
Low Porosity

Cerebral aneurysms are a significant concern; they are found in 2% of the world population [1]. While endovascular treatments have become a successful option for patients with cerebral aneurysms, recurrence rates remain as high as 50% [2]. Accordingly, many interventional devices are being developed with the hope of increasing the success rate of endovascular aneurysm occlusion. One of these devices is the low-porosity Pipeline emboilzation device (PED). Compared to more traditional intracranial stents, the PED contains a higher ratio of metal to surface area. Previously, similar reductions in porosity were obtained by sequentially deploying multiple high-porosity stents inside of one another, which is known as “telescoping.” The hemodynamic effects of using a single low-porosity device, versus telescoped high-porosity stents, have not been investigated thoroughly. In this study flow was quantified for idealized and anatomical basilar tip aneurysm models. The models were treated with sequentially placed high-porosity stents and a single low-porosity PED.

scholarly journals Size-Dependent Distribution of Patient-Specific Hemodynamic Factors in Unruptured Cerebral Aneurysms Using Computational Fluid Dynamics

Diagnostics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 64 ◽  
Author(s):  
Ui Yun Lee ◽  
Gyung Ho Chung ◽  
Jinmu Jung ◽  
Hyo Sung Kwak
Keyword(s):  
Fluid Dynamics ◽  
Shear Rate ◽  
Blood Viscosity ◽  
Cerebral Aneurysms ◽  
Velocity Shear ◽  
Patient Specific ◽  
Complex Flow ◽  
Size Dependent ◽  
Unruptured Cerebral Aneurysms ◽  
Small Aneurysms

Purpose: To analyze size-dependent hemodynamic factors [velocity, shear rate, blood viscosity, wall shear stress (WSS)] in unruptured cerebral aneurysms using computational fluid dynamics (CFD) based on the measured non-Newtonian model of viscosity. Methods: Twenty-one patients with unruptured aneurysms formed the study cohort. Patient-specific geometric models were reconstructed for CFD analyses. Aneurysms were divided into small and large groups based on a cutoff size of 5 mm. For comparison between small and large aneurysms, 5 morphologic variables were measured. Patient-specific non-Newtonian blood viscosity was applied for more detailed CFD simulation. Quantitative and qualitative analyses of velocity, shear rate, blood viscosity, and WSS were conducted to compare small and large aneurysms. Results: Complex flow patterns were found in large aneurysms. Large aneurysms had a significantly lower shear rate (235 ± 341 s−1) than small aneurysms (915 ± 432 s−1) at peak-systole. Two times higher blood viscosity was observed in large aneurysms compared with small aneurysms. Lower WSS was found in large aneurysms (1.38 ± 1.36 Pa) than in small aneurysms (3.53 ± 1.22 Pa). All the differences in hemodynamic factors between small and large aneurysms were statistically significant. Conclusions: Large aneurysms tended to have complex flow patterns, low shear rate, high blood viscosity, and low WSS. The hemodynamic factors that we analyzed might be useful for decision making before surgical treatment of aneurysms.

Patient-Specific Stented Coronary Bifurcations: Numerical Analysis of Near-Wall Quantities and the Bulk Flow

2013 ◽  
Author(s):  
Claudio Chiastra ◽  
Stefano Morlacchi ◽  
Diego Gallo ◽  
Umberto Morbiducci ◽  
Rubén Cárdenes ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Shear Stress ◽  
Coronary Arteries ◽  
Fluid Dynamic ◽  
Patient Specific ◽  
Wall Region ◽  
Stent Restenosis ◽  
Local Measurements ◽  
In Stent Restenosis

The mechanisms and the causes of the in-stent restenosis process in coronary arteries are not fully understood. One of the most relevant phenomena, which seems to be associated to this process, is an altered hemodynamics in the stented wall region [1]. In vivo local measurements of velocities and their gradients in human coronary arteries are very difficult and can hardly be applied to successfully investigate the fluid dynamic field [1]. Alternatively, virtual models of blood flow in patient-specific coronary arteries allow the study of local fluid dynamics and the computation of the wall shear stress (WSS) and other quantities which can be related to the risk of restenosis.

scholarly journals Physics-constrained intraventricular vector flow mapping by color Doppler

2021 ◽  
Author(s):  
Florian Vixege ◽  
Alain Berod ◽  
Yunyun Sun ◽  
Simon Mendez ◽  
Olivier Bernard ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Optimization Problem ◽  
Regularization Parameter ◽  
Color Doppler ◽  
Scalar Fields ◽  
Patient Specific ◽  
Polar Coordinate System ◽  
Flow Mapping ◽  
Vector Flow Mapping

Abstract Color Doppler by transthoracic echocardiography creates two-dimensional fan-shaped maps of blood velocities in the cardiac cavities. It is a one-component velocimetric technique since it only returns the velocity components parallel to the ultrasound beams. Intraventricular vector flow mapping (iVFM) is a method to recover the blood velocity vectors from the Doppler scalar fields in an echocardiographic three-chamber view. We improved our iVFM numerical scheme by imposing physical constraints. The iVFM consisted in minimizing regularized Doppler residuals subject to the condition that two fluid-dynamics constraints were satisfied, namely planar mass conservation, and free-slip boundary conditions. The optimization problem was solved by using the Lagrange multiplier method. A finite-difference discretization of the optimization problem, written in the polar coordinate system centered on the cardiac ultrasound probe, led to a sparse linear system. The single regularization parameter was determined automatically for non-supervision considerations. The physics-constrained method was validated using realistic intracardiac flow data from a patient-specific CFD (computational fluid dynamics) model. The numerical evaluations showed that the iVFM-derived velocity vectors were in very good agreement with the CFD-based original velocities, with relative errors ranged between 0.3 and 12%. We calculated two macroscopic measures of flow in the cardiac region of interest, the mean vorticity and mean stream function, and observed an excellent concordance between physics-constrained iVFM and CFD. The capability of physics-constrained iVFM was finally tested with in vivo color Doppler data acquired in patients routinely examined in the echocardiographic laboratory. The vortex that forms during the rapid filling was deciphered. The physics-constrained iVFM algorithm is ready for pilot clinical studies and is expected to have a significant clinical impact on the assessment of diastolic function.

scholarly journals Computational Fluid Dynamics for Cerebral Aneurysms in Clinical Settings

2021 ◽  
pp. 27-32
Author(s):  
Fujimaro Ishida ◽  
Masanori Tsuji ◽  
Satoru Tanioka ◽  
Katsuhiro Tanaka ◽  
Shinichi Yoshimura ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Cerebral Aneurysms ◽  
Patient Specific ◽  
Clinical Settings ◽  
Geometry Model ◽  
Aneurysm Wall ◽  
3D Ct Angiography ◽  
Specific Geometry ◽  
Computational Fluid Dynamics Cfd

AbstractHemodynamics is thought to play an important role in the pathogenesis of cerebral aneurysms and recent development of computer technology makes it possible to simulate blood flow using high-resolution 3D images within several hours. A lot of studies of computational fluid dynamics (CFD) for cerebral aneurysms were reported; therefore, application of CFD for cerebral aneurysms in clinical settings is reviewed in this article.CFD for cerebral aneurysms using a patient-specific geometry model was first reported in 2003 and it has been revealing that hemodynamics brings a certain contribution to understanding aneurysm pathology, including initiation, growth and rupture. Based on the knowledge of the state-of-the-art techniques, this review treats the decision-making process for using CFD in several clinical settings. We introduce our CFD procedure using digital imaging and communication in medicine (DICOM) datasets of 3D CT angiography or 3D rotational angiography. In addition, we review rupture status, hyperplastic remodeling of aneurysm wall, and recurrence of coiled aneurysms using the hemodynamic parameters such as wall shear stress (WSS), oscillatory shear index (OSI), aneurysmal inflow rate coefficient (AIRC), and residual flow volume (RFV).

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